Do I have anxiety or depression or is it the menopause?
Having clinical experience in both medical specialities; mental health and women’s hormone health as a menopause specialist I frequently see these two issues overlap. Not only does the menopause transition habitually initiate psychological symptoms, including anxiety, low mood, and a lack of motivation, but a women’s preceding mental health condition can be exacerbated during this time. Worsening premenstrual symptoms (PMS) can occur during the perimenopause which starts to impact quality of life and ability to function. Leaving women feeling scared and concerned with what they are experiencing both physically and mentally during the perimenopause and post menopause.
The erratic hormonal fluctuations during the perimenopause and the general decline in oestrogen, progesterone and testosterone over the menopause transition impact neurological pathways in the brain linked to serotonin, the hormone involved in mood regulation, and cortisol, the hormone involve in our response to stress & danger causing our body to act in emergency mode. Consequently, anxiety, low mood, feeling chronically stressed, emotional lability, low energy levels, poor concentration, increased irritability, feelings of not being able to cope or being overwhelmed and short-term memory issues are all very common.
It’s important for women to understand that up to 75% of women develop these psychological symptoms. They are a consequence of reproductive hormone imbalance and therefore can be effectively treated with hormone replacement therapy (HRT), rather than using psychotropic medication designed to treat mental health conditions.
Many women who I see in our menopause clinic describe how their psychological symptoms have been detrimental to their quality of life, affected their ability to work and have negatively impacted relationships with friends and family. Women often describe withdrawing from their social life, fighting with partners, or suffering with crippling anxiety which prevents them from driving, attending social events or going for work promotions. Up to 7 in 10 women of menopausal age going through divorce acknowledge the menopause as a contributing factor in their relationship collapse.
Psychological symptoms of the menopause
The hormonal changes that occur during the perimenopause and menopause can directly influence our mental well-being and can often cause troubling mental health related symptoms. Many women will not have experienced a mental health condition before reaching their perimenopause and the feelings of severe anxiety, low mood, poor concentration, fatigue, lack of interest or enjoyment in normal life which can arise during this time can be a concern. These symptoms can often go on for some time before being associated with female hormone imbalance, even misdiagnosis with anxiety or depression is common. The most effective treatment is of course to correct the hormone imbalance causing the symptoms. Many women are wrongly offered antidepressants rather than HRT as first line treatment if a holistic approach and investigation of other symptoms associated with the menopause is not assessed.
Having experience of making mental health diagnoses such as generalised anxiety, clinical depression, or more severe mood disorders such as bipolar disorder or psychosis. The symptoms related to the menopause transition which are often similar to that of a mental health condition can be hard to differentiate without a good understanding of both hormone health and mental health. Women suffering from the psychological symptoms often describe their mood changes as quite fluctuating on a cyclical or daily basis, they feel their symptoms are hormone related and they have insight or awareness of the symptoms and the impact on their lives, which often differentiates their symptoms from a chronic mental health condition.
For many women starting HRT can relieve many of these symptoms, however of course not every woman is able to use HRT or would choose to do so. For all women there are some useful lifestyle adjustments that have been shown to improve our mental well-being and help reduce menopausal symptoms.
Diets rich in phytoestrogens including soya, tempeh, beans, and pulses with plenty of additional plant-based nutrients and antioxidants is beneficial. Adopting a healthy approach to movement, daily exercise and time spent outside improves our mood and relieves stress. Socialising regularly or having strong family relationships is a known protective factor. Finding an enjoyable form of meditation, exercise such as yoga/Pilates or partaking in relaxing hobbies such as gardening all help to enrich our lives with techniques and habits that improve our mental well-being.
Talking to a health care professional who is knowledgeable of both mental health and the impact of hormone changes during the perimenopause and beyond is important to receive the most effective evidence-based treatment options.
Kate Organ, MRPharm Hon, MSc
Consultant clinical pharmacist, menopause & mental health specialist